Oropharyngeal Airway Insertion

Question 1

Indications

Answer 1

1. Unconscious patient where there is a need to actively maintain airway patency by displacing the tongue anteriorly
2. Bite block to support ETT placement

Question 2

Contraindications

Answer 2

1. Trismus
2. Gag reflex present
3. Any patient suspected of having neurological injury out of concern for inducing a gag response

Question 3

Precautions

Answer 3

1. Ensure correct measurement of OPA to ensure its correct application and ensure it is not too large that it damages structures
2. A modified technique is employed in paediatric patients to avoid hard and soft palate trauma
3. OPA does not provide protection against aspiration

Question 4

Components of OPA insertion

Answer 4

1. Prepare patient
   - manual airway clearance
   - triple airway manoeuvre
2. Prepare OPA
   - select appropriate size by measuring from angle of jar to middle of the incisor
   - Lubricate with water or patients saliva
3. a) Adult insertion
   - Hold OPA by flange
   - natural curve facing upwards
   - pass tip and insert halfway into mouth
   - rotate 180 degrees over the tongue while you push it in
   - if pt gags remove immediately
   b) Paediatric insertion
   - do not rotate on insertion. insert with curve in final position
   - laryngoscope can be used to help guide OPA over tongue
   c) Final position
   - gently advance OPA until flange rests against patients lips
   - ensure patient’s lower lip is not pinched
4. Check
   - check for gag reflex
   - maintain triple airway manoeuvre
   - maintain positioning
   - look, listen and feel for breathing